Journal of neurosurgery. Pediatrics
-
J Neurosurg Pediatr · Jan 2009
Review Case ReportsPediatric spinal clear cell meningioma. Case report.
In this report the authors describe a unique case of spinal clear cell meningioma in a 13-year-old girl. Clear cell meningiomas (CCMs) are not uncommon. To the authors' knowledge, 14 cases of pediatric CCM occurring in the spinal canal have been reported. ⋯ Postoperatively there has been no recurrence in > 2 years. In this paper the authors report a case of CCM and provide a comprehensive literature review on this disease. Current recommendations for its management are still debatable, especially in the pediatric population, and the authors propose an algorithm for its treatment and surveillance.
-
J Neurosurg Pediatr · Jul 2008
Review Case ReportsThe importance of the cortical subarachnoid space in understanding hydrocephalus.
In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. ⋯ The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.
-
J Neurosurg Pediatr · Jun 2008
ReviewA 15-year review of pediatric neurosurgical fellowships: implications for the pediatric neurosurgical workforce.
The Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) was established in 1992 to oversee fellowship training in pediatric neurological surgery. The present study is a review of all graduates from 1992 through 2006 to identify predictors of American Board of Pediatric Neurological Surgery (ABPNS) certification. ⋯ Although the present training infrastructure has the theoretical capacity to train > 20 pediatric neurosurgeons each year, this analysis suggests that current levels will provide approximately 6 ABPNS-certified pediatric neurosurgeons annually. This raises the question of the sufficiency of the future pediatric neurosurgical workforce.
-
J Neurosurg Pediatr · Jan 2008
ReviewAntibiotic prophylaxis for surgical introduction of intracranial ventricular shunts: a systematic review.
Systemic antibiotics and antibiotic-impregnated shunt (AIS) systems are often used to prevent shunt infection. The authors conducted a systematic review to evaluate its effectiveness of antibiotics in patients who underwent placement of intracranial ventricular shunts. ⋯ The authors found a benefit of systemic prophylactic antibiotics in preventing shunt infection, regardless of the patient's age and the type of internal shunt used. The benefit of its use after the first 24 hours postoperatively remains uncertain. Future trials should be conducted to evaluate the effectiveness of different regimens of systemic antibiotics rather than placebo, namely single preoperative dose versus multiple doses. It should also be mandatory to evaluate the effectiveness of systemic prophylactic antibiotics for external ventricular drains. Evidence suggests that antibiotic-impregnated catheters reduce the incidence of shunt infection, although more well-designed clinical trials are needed.
-
J Neurosurg Pediatr · Jan 2008
ReviewTransventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review.
Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. ⋯ The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.